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Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives



211 - Get Connected. Get Answers.

Managed Care Reporting Deliverables

Monthly Reports   Prepaid   Shared
022 Post Payment Recoveries (existence of TPL) - M            
055 Pharmacy Report (RX055) - M            
107 Member Service Call Center - M            
109 Marketing Plan Updates - M          
113 Grievance, Appeal and Fair Hearing Log - M          
115 Provider Appeals Reporting - M            
116 Grievance, Appeal and Fair Hearing Log - M            
164 HIV/AIDS - M            
167 Claims Payment Accuracy Report - M            
173 Prepaid Denied Claims Report - M          
175 Hepatitis C - M            
181 Provider Call Center - M          
182 Provider Complaint & Appeal Summary Report - M          
221 Prompt Pre-Processing Report - M            
221 Claims Payment Summary - M            
                 
Quarterly Reports Prepaid   Shared
026 EPSDT Report (CMS 416) - Q/A              
039 Case Management Report - Q/A          
042 CCMP Reports (Chronic Care Management Program) - Q/A          
066 UM Committee Meeting Minutes - Q          
069 Utilization Management Medical Record Review Report - Q          
072 QAPI PCP Profile Reports - Q          
082 PCP Linkages - Q          
114 Grievance, Appeal and Fair Hearing Log (redacted) - Q/A          
117 Grievance, Appeal and Fair Hearing Log (redacted) - Q/A            
119 QAPI Committee (minutes) - Q          
139  Member Advisory Council (minutes) - Q          
145 Fraud and Abuse Activity Report - Q          
183 Claims Processing Interest Payments - Q            
185 Quarterly Unaudited Financial Statement - Q *            
188 PA and Pre-Cert Summary - Q          
217 QAPI Early Warning System Performance Measures - Q          
220 Network Adequacy Review - Q          
220F PCP Care Management - Q          
300 NCCI MCO Cost Savings            
                 
Annual Reports Prepaid   Shared
015  Key Staff Organizational Listing - A          
016  Functional Organizational Chart - Location Listing and Key Staff Job Description - A          
019  Medical Loss Ratio - A            
041  CCMP Policies and Procedures (program evaluation) - A          
044  CCMP Predictive Modeling Specifications - A          
053 NW Provider Development Management Plan - A  

       
058 NCQA PCP-PCMH Recognition Report - A          
068 Utilization Management Medical Record Review Stategy - A          
110 Marketing Activities Annual Review - A          
121 QAPI Program Description and Work Plan - A          
127 QAPI Performance Reporting Measures (Level I and Level II) - A *          
130 QAPI Performance Improvement Projects (descriptions) - A          
131 QAPI Performance Improvement Projects (outcomes) - A          
132 Member Satisfaction Survey Report - A          
133 Provider Satisfaction Survey Report - A          
141 Member Advisory Council - A          
151 Systems Refresh Plan - A          
157 Emergency Management Plan - A          
159 Back-up File List - A          
170 Form CMS 1513 Ownership and Control Interest Statement - A          
184 Annual Audited Financial Statement - A *  

         
189 Independent-Subcontractor EDP Audit (SSAE16) - A          
216 QAPI Impact and Effectiveness of QAPI Program Evaluation - A          

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* Template not provided. Will accept Health Plans' corporate standard.